Acne vulgaris - epidemiology, pathogenesis, clinical features, acne variants, other special
forms of acne, prognosis, local and systemic treatment depending on the form and severity
supplementary measures
- Acne – multifactorial disease primarily in teenagers with follicular plugging & inflammation.
▪ Epidemiology: Most common* skin disease, affects almost everybody. Most common in
puberty.
▪ Pathogenesis: many factors play role:
▪ Altered hormonal status with ↑ androgens (men) ↑ progesterone (women)
▪ Follicular keratinization (follicular cells become cohesive, resulting in microcomedone)
▪ Hyperplasia of sebaceous glands (↑ sebum production)
▪ Colonization of follicles by Propionibacterium acnes
▪ 4 vicious cycle factors:
▪ 1. excessive sebum secretion
▪ 2. excessive follicular keratinization
▪ 3. cutibacterium acnes (anaerobic bacteria that eat sebum grow in porus)
▪ 4. inflammation
, ▪ Clinical manfiestations:
▪ Acne vulgaris – divided into 2 subtypes:
◦ Acne comedonica – open comedones (whiteheads) & closed comedones (blackheads)
developing in sebaceous follicles, on face, chest & mid-back. Black color is melanin
◦ Acne papulopustulosa – follicular pustules or inflammatory pustules
▪ Acne variants with inflammation:
◦ Acne conglobata – inflammatory nodules & pseudocysts with scarring, on face,
sternum & back, in young men
◦ SAPHO syndrome – Synovitis, Acne conglobata, Palmoplantar pustulosis, Hyperostosis
(abnormal bone ossification) & Osteitis (most common in sternoclavicular joints)
◦ Acne inversa “Hidradenitis suppurativa” – furunculoid lesions in axilla, groin, perianal
region & submammary area with sinus tracts & fistulas. (some don’t consider it HS)
◦ Acne tetrad – combination of Acne conglobata, Acne inversa, Perifolliculitis capitis &
Pilonidal sinus, in men.
◦ Acne fulminans – sudden severe acne with systemic signs & symptoms (fever,
leukocytosis, osteomyelitis, pericarditis). Treated first with high-dose GCS
(inflammation) & then Retinoids. In young males.
▪ Other special acne forms:
◦ Mallorca acne – acne flare after intense sun exposure
◦ Contact “cosmetic” acne – due to comedogenic makeup
◦ Chloracne – due to halogenated hydrocarbons exposure
◦ Acne neonatum – due to ↑ hormone levels in utero
◦ Acne infantum – in 3-6m, due to ↑ LH, ↑ FSH & ↑ Testosterone. Also due to use of
mineral oils (for infant care)
◦ Acne excoriée des jeunes filles – mild acne in young women.
Skin picking disorder (SPD) within the group of obsessive
compulsive (OCD) where pts injury on themselves.
◦ Localized acne - Munro nevus & Becker nevus with acne
◦ Mechanical acne – head bands, shoulder pads
◦ Late-onset acne “acne tarda” – onset in women past puberty
▪ Drug-induced acne (→)
▪ OBS not all diseases with comdedones are acne. Favre-Racouchot disease (due to UV)
has comedones. Nevus comedonicus is a nevus with comedones.
forms of acne, prognosis, local and systemic treatment depending on the form and severity
supplementary measures
- Acne – multifactorial disease primarily in teenagers with follicular plugging & inflammation.
▪ Epidemiology: Most common* skin disease, affects almost everybody. Most common in
puberty.
▪ Pathogenesis: many factors play role:
▪ Altered hormonal status with ↑ androgens (men) ↑ progesterone (women)
▪ Follicular keratinization (follicular cells become cohesive, resulting in microcomedone)
▪ Hyperplasia of sebaceous glands (↑ sebum production)
▪ Colonization of follicles by Propionibacterium acnes
▪ 4 vicious cycle factors:
▪ 1. excessive sebum secretion
▪ 2. excessive follicular keratinization
▪ 3. cutibacterium acnes (anaerobic bacteria that eat sebum grow in porus)
▪ 4. inflammation
, ▪ Clinical manfiestations:
▪ Acne vulgaris – divided into 2 subtypes:
◦ Acne comedonica – open comedones (whiteheads) & closed comedones (blackheads)
developing in sebaceous follicles, on face, chest & mid-back. Black color is melanin
◦ Acne papulopustulosa – follicular pustules or inflammatory pustules
▪ Acne variants with inflammation:
◦ Acne conglobata – inflammatory nodules & pseudocysts with scarring, on face,
sternum & back, in young men
◦ SAPHO syndrome – Synovitis, Acne conglobata, Palmoplantar pustulosis, Hyperostosis
(abnormal bone ossification) & Osteitis (most common in sternoclavicular joints)
◦ Acne inversa “Hidradenitis suppurativa” – furunculoid lesions in axilla, groin, perianal
region & submammary area with sinus tracts & fistulas. (some don’t consider it HS)
◦ Acne tetrad – combination of Acne conglobata, Acne inversa, Perifolliculitis capitis &
Pilonidal sinus, in men.
◦ Acne fulminans – sudden severe acne with systemic signs & symptoms (fever,
leukocytosis, osteomyelitis, pericarditis). Treated first with high-dose GCS
(inflammation) & then Retinoids. In young males.
▪ Other special acne forms:
◦ Mallorca acne – acne flare after intense sun exposure
◦ Contact “cosmetic” acne – due to comedogenic makeup
◦ Chloracne – due to halogenated hydrocarbons exposure
◦ Acne neonatum – due to ↑ hormone levels in utero
◦ Acne infantum – in 3-6m, due to ↑ LH, ↑ FSH & ↑ Testosterone. Also due to use of
mineral oils (for infant care)
◦ Acne excoriée des jeunes filles – mild acne in young women.
Skin picking disorder (SPD) within the group of obsessive
compulsive (OCD) where pts injury on themselves.
◦ Localized acne - Munro nevus & Becker nevus with acne
◦ Mechanical acne – head bands, shoulder pads
◦ Late-onset acne “acne tarda” – onset in women past puberty
▪ Drug-induced acne (→)
▪ OBS not all diseases with comdedones are acne. Favre-Racouchot disease (due to UV)
has comedones. Nevus comedonicus is a nevus with comedones.
